Prolonged Emergency Department Stays for Patients With Autism and Acute Mental Health Concerns

Abstract

Background: Children with autism spectrum disorders face high rates of mental health emergencies often requiring hospitalization, but limited psychiatric unit access often leaves them waiting in emergency departments (EDs).

Objective: To determine if autism is an independent risk factor for prolonged emergency department (ED) stays (>90%), ED psychiatric boarding (>24 hours), and prolonged ED boarding (>48 or 72 hours) for children with mental health concerns requiring hospitalization METHODS: This was a retrospective cohort study using the PECARN Registry Dataset from 2016 through 2021. All ED encounters for patients ages 5 to 18 years of age requiring admission for a primary mental health diagnosis were included. The primary outcome was ED length of stay, the primary exposure variable was autism, and potential confounding variables were age, sex, race/ethnicity, and insurance status.

Results: A total of 73,624 ED visits were included, 66,113 visits without autism and 7511 with autism. When adjusted for age, sex, race and insurance, admitted patients with autism had higher odds of a prolonged ED stay (aOR 1.26, 95% CI 1.15-1.38), ED boarding (aOR 1.68, 95% CI 1.41-2.00), and prolonged ED boarding > 48 hours (aOR 3.91, 95% CI 2.62-5.84) and > 72 hours (aOR 3.91, 95% CI 2.14-7.14).

Conclusion: Autism is an independent risk factor for having a prolonged ED stay, for boarding in the ED, and for prolonged ED boarding when presenting to the ED with a mental health crisis that requires hospitalization.

Keywords: autism spectrum disorder; behavioral health; emergency department boarding; pediatric emergency department; pediatric mental health.